April 21, 2023

The prevalence of obesity is rising in patients with inflammatory bowel disease (IBD). However, only limited research data are available to indicate which weight management strategies are most effective in this population. A team of Mayo Clinic researchers seeking to shed light on this topic conducted a retrospective review of seven patients with IBD who underwent endoscopic bariatric therapy (EBT) at Mayo Clinic. The results of the study were published in Obesity Surgery in 2022.

"Obesity impacts the entire spectrum of our population," says Andrew C. Storm, M.D., a gastroenterologist at Mayo Clinic in Minnesota and a co-author on the Obesity Surgery article. "Patients with inflammatory bowel disease, like all patients, need to have options for achieving weight loss to be and feel healthy. There is some debate around the safety of performing bariatric surgery in patients with inflammatory bowel disease. So we felt it was necessary to show the safety of nonsurgical weight-loss procedures in this patient population specifically."

Methods

The researchers conducted a chart review of seven patients with IBD who underwent EBT. They recorded IBD-related and obesity-related histories, as well as available EBT-related and IBD-related data and outcomes. They also analyzed available weight-loss data collected at one, three, six and 12 months after EBT and at last follow-up. And they calculated the percentage excess weight loss (% EWL) at six months and at last follow-up.

Six of the seven patients in the chart review were diagnosed with Crohn's disease and one was diagnosed with ulcerative colitis. Three patients were treated with an intragastric balloon procedure, and four were treated with endoscopic sleeve gastroplasty (ESG). Three patients had prior IBD-related surgery. All seven patients received IBD medications, and six were in clinical remission at the time of EBT.

Results

• Weight-loss outcomes. All five patients with available follow-up data experienced effective weight loss after EBT. The median % EWL within this group of five patients was 27.5% (range, 7% to 46.4%) at six months after EBT and 23.9% (range, 11.4% to 67.7%) at last follow-up. Four of the five patients with available follow-up data experienced improvements in obesity-related comorbidities.
• IBD outcomes. Among the five patients with available follow-up data, IBD outcomes after EBT were generally favorable.
• Procedural safety. None of the seven patients treated with EBT experienced device-related or procedure-related serious adverse events after the procedure.

"Endoscopic bariatric therapies for weight loss — including endoscopic sleeve gastroplasty, a procedure pioneered at Mayo Clinic — are highly effective and safe treatments for obesity and obesity-associated comorbidities," explains Dr. Storm. "Our study offers a description of early experience with the use of endoscopic, nonsurgical procedures as a treatment for weight loss in patients with inflammatory bowel disease.

"While the patient cohort studied is relatively small, our results suggest that endoscopic bariatric therapies are highly safe and effective in this patient population," says Dr. Storm.

For more information

Johnson AM, et al. Endoscopic bariatric therapies for the management of obesity in patients with inflammatory bowel disease. Obesity Surgery. 2023;33:676.

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